Rehabilitation after ACL reconstruction is one of the most demanding physiotherapy protocols — and one of the most decisive for what follows. The quality of rehabilitation determines, as much as the quality of surgery, the return to sport and the prevention of a second rupture. At the Gouizine Clinic in Temsia (Agadir), we follow a structured 4-phase protocol over 6 to 9 months.
What does the ACL do?
The anterior cruciate ligament is one of two ligaments located in the center of the knee. It stabilizes the tibia relative to the femur and prevents forward sliding. Its rupture is very common in athletes practicing pivoting sports (football, skiing, basketball, handball, rugby).
Surgical techniques
Orthopedic surgeons use several techniques to reconstruct the ACL. The most common:
- DIDT (DT4): using the semitendinosus and gracilis tendons
- BPTB (Kenneth Jones): patellar tendon
- QT: quadriceps tendon
- Allograft: donor tendon (rarer in Morocco)
The choice depends on the surgeon, your age, your sport, and the situation. Rehabilitation is nearly identical in all cases.
Why start rehab in the first days?
Early care (24 to 72 hours after the operation) is essential to:
- Limit post-operative swelling and pain
- Prevent scar adhesions and knee stiffness
- Wake up the quadriceps, which becomes inhibited very quickly after surgery
- Learn self-rehabilitation exercises to do at home
- Safely prepare the next phases of recovery
Our rehabilitation protocol
Phase 1 — Protection and early recovery (0–6 weeks)
- Fighting swelling: ice, pressotherapy, drainage
- Recovery of full extension (absolute priority) then flexion (90° by 3–4 weeks, 120° by 6 weeks)
- Waking the quadriceps: isometric contractions, electrostimulation
- Progressive walking with crutches, then weaning according to the surgeon's instructions (often 2 to 4 weeks)
Phase 2 — Muscle strengthening (6–12 weeks)
- Progressive strengthening of the quadriceps, hamstrings, and glutes
- Closed-chain work (leg press, partial squats) then open-chain (controlled extension)
- Stationary bike, swimming (no breaststroke)
- Recovery of full range of motion
- Simple proprioceptive work on platforms
Phase 3 — Return to fitness (3–6 months)
- Progressive return to running (around 3–4 months, on flat ground, after validation of muscular criteria)
- Eccentric strengthening, progressive plyometrics
- Sport-specific work (no contact, no pivots)
- Isokinetic evaluation of quadriceps/hamstring strength
Phase 4 — Return to sport (6–9 months)
- Work on changes of direction, pivots, jumps
- Return-to-sport tests: muscular symmetry ≥ 90%, hop tests, agility tests
- Return to contact and competition after surgeon and physiotherapist approval
How many sessions?
Plan on average 40 to 60 physiotherapy sessions spread over 6 to 9 months. Frequency varies by phase:
- Phase 1: 3 sessions per week
- Phase 2: 2 to 3 sessions per week
- Phase 3: 2 sessions per week + supervised independent training
- Phase 4: 1 to 2 sessions per week + sport-specific training
Pitfalls to avoid
- Returning to running too early (before 3 months and without validated muscle testing)
- Returning to pivoting sport too early (before 6 months) — major risk of recurrence
- Skipping physiotherapy sessions during phase 1 — stiffness sets in within days
- Neglecting home exercises — clinic sessions alone are not enough
- Not performing isokinetic assessment before return to sport
- Comparing to other patients — each rehabilitation has its own pace
Return-to-sport criteria
Return to pivoting sport is only validated if you meet several criteria:
- Post-operative delay ≥ 6 to 9 months
- Quadriceps and hamstring strength symmetry ≥ 90% of the healthy side
- Functional tests (single hop, triple hop, cross-over hop) ≥ 90% of the healthy side
- No residual swelling, no pain
- Recovered confidence — no apprehension
- Joint approval from surgeon and physiotherapist
What next? Long-term prevention
An ACL rupture exposes you to increased risk of early knee osteoarthritis and rupture of the contralateral ACL. To limit these risks:
- Maintain regular physical activity and stable weight
- Keep up proprioceptive and strengthening exercises for life
- Avoid returning to very high-risk sports without specific preparation
- Consult at the slightest recurrence of pain or swelling
Related services
- Functional rehabilitation — complete protocol
- Physiotherapy — basic care
- Pressotherapy — post-operative drainage
- Clinical Pilates — core and stability
- Laser therapy — acute phase